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Individual

CORNELIUS MARTIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
4054 MCKINNEY AVE STE 102, DALLAS, TX 75204-2050
(214) 520-6308
Mailing address
4054 MCKINNEY AVE STE 102, DALLAS, TX 75204-2050
(214) 520-6308

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
S18803
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
86478Q
BC/BS
01
9398151
PHCS
Enumeration date
07/04/2006
Last updated
07/08/2007
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